Abstract Details

Title Mechanical Thrombectomy in Tandem Lesion: Effects of Extracranial Carotid Dissection Versus Atherosclerosis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S6 - Stroke Pathophysiology and Prediction (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Background Tandem lesions account for 10-20% of acute LVOs, and are associated with worse prognosis. Current studies have shown contradictory results when comparing outcomes in patients with atherosclerotic versus dissection of the cICA.

Objective To investigate the effect of the cervical internal carotid artery (cICA) lesion etiology on patients with acute large vessel occlusions due to tandem lesions (TL-LVO) who undergo endovascular treatment (EVT).

Design/Methods In this multi-center retrospective study from 16 Comprehensive Stroke Centers, we included adult patients with acute LVO-TL and underwent EVT. TLs were defined as intracranial(petrous to proximal ACM-M2) occlusion plus cICA steno-occlusive lesions(>70%). The primary outcomes were 90-days mRS 0-2 and successful reperfusion post-procedure(mTICI 2b-3). Secondary outcomes were ordinal shift on 90-days mRS and mTICI, mTICI 2c-3, symptomatic intracranial hemorrhage, any intracranial hemorrhage, early neurological improvement [admission NIHSS - discharge NIHSS >4], distal embolisms during/at the end of the procedure, and in-hospital and 90-days mortality. We used descriptive statistics and Inverse Probability of Treatment Weighting to compare patients with dissection versus those with atherosclerosis of the cICA lesion.

Results We included 526 patients. The median[IQR] age was 68[59-76] years, and 31% were females. 59(11.2%) presented dissection and 467(88.8%) atherosclerosis. Patients with dissection were younger (52vs.69 years, p=<0.001), had lower rates of hypertension (52.5vs.74.5%, p=<0.001), hyperlipidemia (27.1%vs.49.2%; p=0.001), and DM (15.3vs.29.8%, p=0.019). Matched analysis showed that patients with dissection had significant lower rates of successful reperfusion (79.7 vs. 89.1%, aOR 0.39, 95%CI 0.16–0.93, p=0.34) compared to patients with atherosclerosis, and greater rates of new distal embolization during the procedure (17.5vs.7.7%, aOR 2.53, 95%CI 1.15-5.55, p=0.21). No differences were observed in other outcomes.

Conclusions We found that in patients with acute stroke due to TLs, the etiology of the cervical lesion matters. Patients with dissection had lower odds of successful reperfusion, most likely due to higher rates of new distal embolisms during EVT.

Authors/Disclosures
Milagros Galecio-Castillo, MD (University of Iowa Hospitals and Clinics) PRESENTER	Dr. Galecio-Castillo has nothing to disclose.
Darko E. Quispe Orozco, MD (TTUHSC-SOM, Lubbock; Neurology Dept.)	Dr. Quispe Orozco has nothing to disclose.
Mouhammad A. Jumaa, MD (ProMedica Stroke Network)	Dr. Jumaa has nothing to disclose.
Afshin A. Divani, PhD (University of New Mexico)	The institution of Dr. Divani has received research support from Department of Defense.
Marc Ribo (Hospital vall d'Hebron)	No disclosure on file
Michael G. Abraham, MD (The University of Kansas Health System)	Dr. Abraham has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stryker Neurovascular.
Nils Petersen, MD (Yale University)	Dr. Petersen has received research support from NIH.
Johanna T. Fifi, MD, FAAN (Mount Sinai Hospital)	Dr. Fifi has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Stryker, Inc. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Dr. Fifi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Fifi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Serenity. Dr. Fifi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MIVI. Dr. Fifi has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. Dr. Fifi has stock in Endostream. Dr. Fifi has stock in Synchron. Dr. Fifi has stock in Imperative Care. Dr. Fifi has stock in Truvic. Dr. Fifi has stock in Bendit. Dr. Fifi has stock in Cerebrotech. Dr. Fifi has stock in Sim&Cure. Dr. Fifi has stock in Q'Apel. The institution of Dr. Fifi has received research support from Viz AI.
Waldo Guerrero, MD (University of South Florida College of Medicine)	Dr. Guerrero has nothing to disclose.
Amer Malik, MD (University of Miami Miller School of Medicine)	Dr. Malik has nothing to disclose.
James E. Siegler III, MD (University of Chicago)	Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various medicolegal cases. The institution of Dr. Siegler has received research support from Viz.ai.
Thanh Nguyen, MD	Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vesalio. Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avania. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Nguyen has received research support from Boston Medical Center. The institution of Dr. Nguyen has received research support from Society of Vascular and Interventional Neurology.
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Albert Yoo (Texas Stroke Institute)	No disclosure on file
Guillermo Linares, MD	Dr. Linares has nothing to disclose.
Nazli A. Janjua, MD, MBBS	Dr. Janjua has nothing to disclose.
Wondwossen G. Tekle, MD	Dr. Tekle has nothing to disclose.
Mohamad Abdalkader (Boston Medical Center Deptartment Of Radiology)	Mohamad Abdalkader has nothing to disclose.
Jazba Soomro, MD (Texas Stroke Institute)	Dr. Soomro has nothing to disclose.
Juan A. Vivanco-Suarez, MD	Mr. Vivanco-Suarez has nothing to disclose.
Aaron E. Rodriguez-Calienes (University of Iowa Hospitals and Clinics)	Dr. Rodriguez-Calienes has nothing to disclose.
Maxim Mokin, MD, PhD (University of South Florida)	Dr. Mokin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Mokin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Mokin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Dr. Mokin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Mokin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Foley Mansfield.
Dileep R. Yavagal, MD, FAAN (University of Miami Miller School of Medicine)	Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vascular Dynamics. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. The institution of Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus/Johnson & Johnson. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Poseydon. Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Athersys. Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gravity Medical Technology. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Poseydon. Dr. Yavagal has stock in Poseydon. Dr. Yavagal has stock in Galaxy Therapeutics. Dr. Yavagal has stock in Stentrode. Dr. Yavagal has stock in Gravity Medical. Dr. Yavagal has stock in Gravity Medical Technology. Dr. Yavagal has stock in Athersys. Dr. Yavagal has stock in Rapid Medical . Dr. Yavagal has received intellectual property interests from a discovery or technology relating to health care. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Expert with Royal Carribean Cruise Line. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Consultant with Carnival Cruise Line.
Ameer Hassan, DO (Valley Baptist Medical Center)	Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH.